Manager Clinical Quality
UnitedHealth Group
PA
hace 3 días

Position Description

Talk about meaningful work. Talk about an important role. Let's talk about your next career move. Delivering quality care starts with ensuring our processes and documentation standards are being met and kept at the highest level possible.

This means working behind the scenes ensuring a member-centric approach to care.

The Quality team is seeking a Manager Clinical Quality. You will monitor and support the health plan quality improvement initiatives with particular emphasis on HEDIS and State Performance measures.

You'll act as a voice for our members, guiding the development of comprehensive care plans that will help others live healthier lives.

Here's your opportunity to discover your life's best work.(sm)

Primary Responsibilities :

  • Oversees the implementation of plan quality improvement program
  • Works to coordinate the work within C&S Quality in order to improve HEDIS performance and to close gaps in care
  • Manages Quality Playbook and work plan programs and activities
  • Collaborates across business segments to achieve goals and targets
  • Develops and maintains positive relationships external state organizations within the scope of Quality Improvement
  • Continuously monitors HEDIS and state performance measure results and adjust programs to insure meeting targeted goals
  • Supports PIPS, accreditation, and regulatory audits as needed
  • Interviews, hires, and supervises quality department staff
  • Develops, mentors, and coaches staff.
  • Oversee HEDIS data collection process and annual state performance measure collection process.
  • Required Qualifications :

  • Bachelor’s degree or RN (with license in PA)
  • 2 years HEDIS and NCQA experience
  • 1+ year of experience with managed care and insurance industry
  • Experience in writing reports and analyzing performance data
  • Experience creating detailed reports and presenting them on various state projects
  • Preferred Qualifications :

  • Performance Driven
  • Experience with Corrective Action Plans
  • Strong influencing and negotiation skills
  • Able to make independent decisions
  • Change management experience and demonstrated skills
  • Demonstrated staff development skills
  • Strong team building, collaboration and motivational skills
  • Results-oriented
  • Knowledgeable of the managed care / health insurance industry, products and services
  • Knowledge of NCQA accreditation standards, HEDIS, STARS, Regulatory Adherence and Performance Improvement Projects
  • Experience in project management strongly preferred
  • Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here.

    We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV / AIDS and high-

    risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors.

    Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most.

    This is the place to do your life's best work.(sm)

    Diversity creates a healthier atmosphere : UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

    UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

    Job Keywords : RN, Registered Nurse, Quality, Manager, Quality Manager, HEDIS, NCQA, STARS, Medical Record, Project Improvement, Quality Improvement, Performance Improvement, data management, PA, Pennsylvania, telecommute, telecommuter, telecommuting

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